Depression in the Schizophrenic1

The thesis of this paper is that, in the course of development, schizophrenics reach the depressive position and, finding it intolerable, deal with it by projecting their depressive anxieties. This can only be done by projecting a large part of their ego into an object, that is by projective identification. I am speaking here of the depressive position as described by Melanie Klein. Briefly, this is a phase of development in which the infant's ego is integrated enough and the object synthesized enough for the infant to experience a whole object relation involving ambivalence, dread of loss, guilt, and the urge to regain and restore the object. By projective identification I mean that process in which a part of the ego is split off and projected into an object with a consequent loss of that part to the ego, as well as an alteration in the perception of the object.

In the course of psycho-analytic treatment of the schizophrenic, it is of great importance to put him in touch with his depressive feelings and the wish to make reparation which springs from them. As the treatment progresses, and after some analysis of the paranoid anxieties, idealizing and splitting processes, the patient comes more and more frequently to experience, for a short time, depressive anxieties. He usually tries to get rid of these anxieties by projective identification. Very often it will be found that the depressive part of the patient's ego is projected into the analyst, and in order to achieve that projection the patient may resort to careful stage-managing of the analytical situation designed in a way to provoke depressive feelings in the analyst. It is of great importance, then, to find where and in what circumstances the part of his ego capable of experiencing depression has been projected and to interpret this to the patient.

I will illustrate what I mean by two examples taken from the analysis of a 16-year-old schizophrenic girl. She had suffered from hallucinations from the age